Provider Demographics
NPI:1013428044
Name:SWANSON, ASHLEY TAYLOR (MSOTR/L)
Entity type:Individual
Prefix:
First Name:ASHLEY TAYLOR
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MARYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1728
Mailing Address - Country:US
Mailing Address - Phone:570-674-5178
Mailing Address - Fax:
Practice Address - Street 1:702 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5845
Practice Address - Country:US
Practice Address - Phone:570-285-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009511225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty